Working conditions for doctors do not depend only on pay
Editor - I disagree with the sentiments about doctor's pay expressed by Patel in his letter.1 A profession is defined by a degree of autonomy or self regulation, and its primary motivation is the welfare of the client or patient. Professionals need not bankrupt themselves for this, but equally the service they offer is not dependent on the depths of the patients' pockets, all the more so when the state is the entity paying for the service, as in medicine. An appropriate comparable career would be teaching. We need the best people to be our teachers, yet no one seems to suggest that teachers' wages should reflect those of city workers. Even if this were the case, we would be nervous about having our children taught by people whose prime motivation is profit.
Those put off a career in medicine by the "low pay" are probably best out of it. Medicine is a vocation. Those who are motivated by profit in their career choice should steer clear. Patel seems to be surrounded by fellow students whose career choices were made on the basis of their future earnings. This is not my experience of 16 year olds. Even if it were, we should not make policy on the basis of adolescent competitive greed.
Junior doctors' working hours and conditions are poor. The hours worked by a doctor, however, are comparable to those of a company secretary or junior in a law firm, and not all city firms' employees can claim wages that outstrip those of doctors. Doctors' pay changes little wherever in the country they work. The same is not true of accountants, lawyers, or most other careers.
It is true that city traders can earn vast amounts of cash very early in their careers, while doctors are still in clinical training. These tend to be the careers, however, that burn out their workers at a very early age whereas medicine, with its slow but steady wage increase, can provide job security for life.
Patel claims that positions in public service are filled by those willing to tolerate the poor conditions. I think that public servants are those who are willing to exchange the higher wages in the private sector for job security, reasonable hours, weekends off, and the privilege of being a public servant. These are exactly the people we want in such jobs.
Even if the NHS could actually afford to pay more, working conditions might be improved in other, better ways. If we spent more money on training nurses, creating some "super nurses," the responsibilities that they would be deemed capable of fulfilling might reduce the workload of junior doctors. Improving the lives of doctors is not just about giving them more cash - lifestyle factors are always the reasons that city professionals give for leaving one job and taking a slightly less well-paid alternative. We should improve doctors' lives but also ensure that the doctors we have are those who truly want to be here.
Anthony Norman, third year medical student, Royal Free Hospital and University College Medical School, London NW3 2PF
studentBMJ 1999;07:394-436 November ISSN 0966-6494
- Patel K. Doctors' pay must match that of other professionals. studentBMJ 1999;7:299. (August.)
